From his distant vantage point treating Marines at a base in Iwakuni, Japan, Russell, 46, has been speaking out for three years that the U.S. military faces a mental health crisis in the treatment of its combat veterans.

He has fired off memos to higher command and has gone public with his views, an unusual step for many in the military. Russell discussed his concerns in phone and Internet interviews.

"We cannot provide the standard of care to treat PTSD via psychotherapy when we can barely keep up with new referrals and have to manage crises while filling in for the staffing gaps and vacancies due to deployment, attrition or no billeting," Russell says. "This is why I have been so outspoken."

"Mark really has a tremendous amount of compassion and a real desire to make sure that everyone gets what they need," says Navy Capt. Warren Klam, a psychiatrist and senior medical officer for mental health at the Naval Medical Center in San Diego and a member of the Mental Health Task Force. "I just think if you look at the bigger picture, it's not nearly as much of a concern as it might sound. I think DOD (Department of Defense) is very sensitive to this issue and is trying to work very hard."

The Navy serves all the medical and mental health needs of the Marine Corps.

Russell says his immediate commanders at the Marine Corps base have been supportive and encouraged him to speak out. Most recently, they arranged for him to testify at a San Diego hearing held by the Pentagon's Task Force on Mental Health. Congress authorized the task force to examine mental health care in the military. The title of Russell's presentation was "Perfect Storm."

During that testimony, Russell presented data showing:

•Mental health trauma is on the rise. Army studies show that more than a third of combat-deployed troops seek mental health care when they return home.

•Training for mental health professionals is inadequate. A survey by Russell of 133 military mental health providers done from 2003-05 shows that 90% of the psychiatrists, psychologists and social workers reported no formal training or supervision in four PTSD therapies recommended by the Pentagon and Department of Veterans Affairs.

•Staffing is down. Russell says vacancies remain for mental health providers in the Navy. In addition, psychiatrists and psychologists deployed overseas deplete resources at home, and burnout makes it hard to keep skilled therapists on staff, he says. His concerns were supported by a 2005 Army study showing one of three mental health providers deployed in the war zone report high burnout or low motivation or morale.

Klam says the Army and Navy have emphasized providing mental health counseling in war zones at an unprecedented level.

As a result, he says, the military has a record of returning more than 98% of troops with emotional issues back to their units.

In addition, he says, the Pentagon has aggressively worked to screen troops as they leave the battlefield and after they arrive home to learn about lingering physical or mental problems. Klam says training in the core therapy areas has been increasing.

He concedes, however, that staffing continues to be an issue. His complement of a dozen psychology positions at the medical center is down by half. He has brought in four civilian psychologists to fill in.

Staff shortages

Navy Cmdr. Richard Bergthold, a psychologist, says he has no way to verify Russell's assertions about the broad lack of formal training in key therapies.

Bergthold agreed that recruitment and retention of psychologists and psychiatrists in the Navy is a continuing problem. He says the Navy has 72% of the psychologists and 62% of the psychiatrists it needs, although trainees will raise staffing levels to 85% for psychologists and 91% for psychiatrists.

After Russell raised his concerns, Bergthold says he canvassed several senior mental health officials within the Navy.

"They do not believe we are currently in a crisis," Bergthold says. "However, if the Navy were to stand still and do nothing — which it's not — we would find ourselves quickly overwhelmed. … If we see this conflict go on with an increased number of folks returning with stress disorders, it's a question of mathematics."

Army staffing levels for uniformed psychiatrists and psychologist are at 80%-85%, but the Army has contracted with large numbers of civilian mental health officials to help in assisting soldiers.